Category: Feeding, Personal Hygiene, Toileting

Posted in Down syndrome, Dual Diagnosis Down syndrome and autism, Feeding, Personal Hygiene, Toileting, Independent living skills, Parenting Special Needs, Self-care for special needs parents

Blog #252~DS-ASD:Teaching Personal Hygiene and Independent Living Skills at Home

Posted on by tjunnerstall

Blog #252~DS-ASD:Teaching Personal Hygiene and Independent Living Skills at Home

The importance of teaching personal hygiene and other independent living skills at home can’t be emphasized enough. Parents, caregivers, teachers and aides are all on the front lines to support individuals with a dual diagnosis of Down syndrome and autism (DS-ASD). My son Nick is 29 years old and has DS-ASD, and honestly one of the most challenging areas to teach is personal hygiene. One thing that I have learned over the years is that it is never to early or late to work on these skills. This week we will examine specific skills and strategies to teach your loved one with DS-ASD.

Personal Hygiene and Independent Living Skills at Home:

*Using the toilet

*Putting clothes in the hamper/ hanging up towel

*Picking out clothes to wear/ dressing skills

*Brushing Teeth/ flossing

*Washing hands & face

*Putting on deodorant

*Shaving

*Beauty Regimens

*Menstrual cycle cleanliness

*Bathing/ showering & drying off

*Brushing hair

*Blowing nose

*Clipping nails/ tolerating and desensitizing nail clipping

From the list above, consider the strengths of your child, start with a more preferred activity and build from there. Offer support using visuals or visual modeling with breakdown of the steps. Here are a few examples, many of which you can get from Google Images and YouTube. Consider whether the child responds better to understanding actual photographs, videos or Picture Exchange Communication(PECS) Symbols. Many speech and occupational therapists have visual supports that they can share with you. So, be sure to ask your child’s school or private therapists for these as well.

Washing Hands Routine:

Shaving Photo Visuals on a Key Ring:

Video Modeling of Brushing Teeth:

Over the years, we have used all of these visual supports and modeling techniques to teach these tasks. It can be very beneficial to work with a BCBA behaviorist who can help target skills, breakdown the steps and practice on a consistent basis. The BCBA can also build in schedules and rewards to help support and motivate your child.

Here are some great resources for teaching personal hygiene and boundaries by author Mary Wrobel:

Independent living, hygiene and home management skills help to build confidence, a sense of ownership and belonging. Building these skills sets will give your child more jobs/day program and housing options when they become an adult.

To view more independent living skills click on the two previous blogs:

Blog #250~DS-ASD:Teaching Independent Living Skills
Blog #251~ DS-ASD: Independent Living Skills at Home

We hope that you have gained some insight and strategies for building independence from the past three blogs #250-252. Our goal and passion is to make this road of a dual diagnosis easier for other families. We also want to inspire you as a parent, teacher or caregiver to help your child reach their full potential. 🙂

For more information on navigating co-occurring DS-ASD in my book. Click here to order: https://amzn.to/2W3Un6X

That’s what is in my noggin this week.

~Teresa 🙂

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Posted in Autism, Doctors and Dentists, Down syndrome, Dual Diagnosis Down syndrome and autism, Feeding, Personal Hygiene, Toileting, Resources for Special Needs

Blog #214~ How to Make a Social Story

Posted on by tjunnerstall

Blog #214~How to Make a Social Story

A social story is a visual support that helps individuals understand new events, and reinforces a desired skill, task, or behavior.  They are useful for individuals that have Down syndrome, autism or other intellectual/developmental disabilities.  My son, Nick is 24 years old and has a dual diagnosis of Down syndrome and autism.  Over the years, we’ve used social stories to help him navigate new situations like starting back to school, doctors and dentist appointments, vacations, and independent living skills such as showering and brushing teeth.  Social stories provide a blueprint as to what will occur and what is expected from a behavior standpoint.  Knowing what will happen and what’s expected, will also help to reduce anxiety.

social-stories go to class

As you can see from the illustration above, a social story should use succinct wording and may include visual, depending on the ability and age of the child.  Individuals with autism often understand better with pictures.  Support teachers and speech therapists are great resources for creating social stories for your child.  Google Images and Pinterest both offer many social stories to help you get started.

How to Make a Social Story:

1. Choose a specific event (starting school, a doctor visit, hygiene routine).

2. Break the story down into steps, including who, what, (and why depending on the child’s cognition level).  Use the pronouns “I” or “we”.

3. State the desired behaviors that you want the person reading the story to do for each step.

4. Include visuals either on-line or actual pictures of the setting.

5. Show the desired outcome, this may include a reward or verbal praise like “good job”.

6. Read the story together with the child repeatedly for several weeks before the event or new routine occurs.

hand_washing_routine

social story morning routine

Some individuals may respond better to video modeling.  Making a video of the desired task or behavior can help a child learn a new routine, adjust to a new environment or learn a skill.  As with social stories, the script should be simple in wording and broken down step by step.

Both social stories and video based modeling can help teach new skills, venues and routines.

Here are a few more ideas for using social stories or video modeling to teach your child:

*New job skill

*Fine motor tasks (cutting food, buttoning a shirt, pouring milk, handwriting)

*Gross motor skills (swimming strokes, riding a bike, yoga, sports)

*Grooming and hygiene routines (brush teeth, shower, toileting, dressing)

*Morning, afternoon and bedtime routines

*Household chores

*School Routines ( new school, picture day, assemblies, new curriculum in PE)

*Visits to doctor, dentist, blood draws, haircuts

*Community trips, vacations and special events

*Teaching social skills (playing games with peers, turn taking)

When you know what is going to occur, you feel less anxious.  Fear can lead to avoidance for all of us.  Utilizing social stories can help guide a child to understand what will happen, where and what is expected of their behavior.  It’s a great visual tool for teaching new skills and routines.  As the new school year begins, create a social story that includes actual pictures of the school building, classroom, lunchroom, gym and any other areas your child will be in.  Social stories will help to guide your child to smooth and successful experiences both at home, school and in the community.  That’s what is in my noggin this week.

~Teresa 🙂

Follow Nick:

Facebook and Pinterest @Down Syndrome With A Slice Of Autism

Instagram @nickdsautism

Twitter @tjunnerstall

 

 

Posted in Autism, Dual Diagnosis Down syndrome and autism, Feeding, Personal Hygiene, Toileting

Blog #170~Teaching Independent Living Skills

Posted on by tjunnerstall

Blog #170~Teaching Independent Living Skills

Brushing your teeth, bathing, dressing, and doing household chores, are all a part of what a parent teaches their child.  But what if you are a parent of a child with special needs?  How do you teach these independent living skills?

Nick vacumming_Tabor Hills (3)

My son Nick is 23 years old and has a dual diagnosis of Down syndrome and autism.  He has learned many self-help skills, and assists around the house with several chores.  These independent living skills give him a sense of accomplishment and pride.  It also takes the burden off me as his mom.

So how do you get started?  First, identify areas that you want to work on with your child.  Pick just one skill, that your child can do with assistance.  This skill should have value and interest to them.  Take for instance the task of washing your hands.  This was something my son liked to do because he enjoys running the faucets. 😉  The next step is to break down the task into simple steps.  Take these simple steps and determine what supports are needed to teach this skill.  For a child that has autism, it helps greatly to provide visual supports.  This can be written instructions, using picture sequences, or video modeling.

Picture sequence for washing hands….

handwashing routine

When using picture sequences, determine with your child’s teacher, if it’s more effective to use the style above, or actual photographs of the sequence.  Each child is different in how they can understand pictures. You can find many picture sequences on Google Images, or ask your child’s support teacher to make you some.  Another option is to use an iPad, and download apps that show these sequences.  There are tons apps available, here is just one of many:

iPad App called iDo Hygiene (free app)….

iDo hygiene

Once the visual supports are in place, you can guide your child step by step, using “hand over hand technique” to teach the motor skills.  As your child develops these skills, begin to fade back, by point prompting to each picture.  Be sure to use lots of praise and cheer them on their successes.

Here are a few examples of other self-help skills that you can work on with your child around the house:

*Hygiene skills like brushing teeth, showering, washing face and hands, brushing hair, toileting, shaving.

*Recycling and can crushing

*Shredding

*Help with laundry

Nick laundry

*Unload the dishwasher

*Set the table

*Make the bed

*Fold and put away laundry

*Water plants

Nick watering plants

*Cleaning windows and countertops

*Dusting

*Unload groceries and put them away

Nick toilet paper

*Cooking

*Vacuuming

Many of these household chores provide great sensory input.  Push and pull activities like carrying laundry baskets and vacuuming, are excellent examples.  Heavy work provides proprioceptive input to the muscles & joints.  This can be very calming, organizing, and regulating, decreasing stress and anxiety.

Not all of the skills above are Nick’s favorites to do.  As a parent,  you can determine which activities are more motivating for your child.  Focus on those first.  Nick really enjoys vacuuming.  Another strength Nick has is matching, and remembering where things go.  So for him, unloading the dishwasher and putting groceries away were both easier and motivating for him to do.

Teaching your child independent living skills, will strengthen their abilities to hold a job in the future.

Nick doing volunteer work at GiGi’s Playhouse…

nick-cleaning-gigis

It also fosters a sense of fulfillment and gratification for them, as well.  So, pick one task, roll up your sleeves and get to work. That’s what is in my noggin this week!

~Teresa 🙂

Follow Nick:

Facebook and Pinterest @Down Syndrome With A Slice Of Autism

Instagram #nickdsautism

Twitter @tjunnerstall

 

 

 

 

 

Posted in Autism, Down syndrome, Dual Diagnosis Down syndrome and autism, Education and Special Needs, Feeding, Personal Hygiene, Toileting, Parenting Special Needs, Resources for Special Needs

Blog #164~Why Use a Visual Schedule?

Posted on by tjunnerstall

doctor-checkup

Blog #164~Why Use a Visual Schedule?

We all hate getting lost, it can be aggravating  and nervewracking. That’s why we use maps to help navigate our way.

mapquest

The same is true for a child with special needs who lacks verbal and cognitive skills.  Providing a visual schedule allows your child to see what is going to happen in their day. My son, Nick is 22 years old and has Down syndrome and autism. Visual schedules provide many benefits for him to travel smoothly, through his daily routine.

Nick fist bump AID

Benefits of Using a Visual Schedule:

*Provides structure and predictability by showing a child what is coming up next.  This greatly reduces anxiety and builds confidence.

*Helps with transitions from one activity to the next.

*Picture form is easier to understand than verbal instructions.  Children with autism often comprehend pictures and/or written directions easier than verbal cues alone.

*Helps to teach sequence of events especially when using words, “first”, “next”, and “last”.

*Expedites learning routines and fosters independence in self-help/hygiene skills and household/school jobs.

handwashing-routine

*Helps with time management and literacy development by reading through pictures and words associated with them.

*Improves conversation skills by giving a visual framework of what they did and what was their favorite part of the end of the day.

*Assists teachers and caregivers with routine changes, when things get out of sync.  It also helps to introduce a new and/or different activity.

dentist-checkup-visual

Visual schedules come in all shapes and forms and many are available in Google images.  You can adjust the length and type of images, (PECS-Picture Exchange System, photos, written words,  iPad/ smart phone apps) to what your child will most easily understand.

first-then-app

It’s best to start with a small routine and adapt the schedules based on your child’s needs and abilities. Try pairing a non-preferred activity (first) followed by a preferred choice (next).  Your child’s speech therapist can be of great help in creating picture sequences that would fit their needs.

Going through a visual schedule with your child, helps them understand what is going to happen, and what behavior you expect.

Here is one we use when going to the mall.  Note the visual below has going to the stores (first)  and Taco Bell (next) as the preferred activity.

IMG_3865

Sequence for going to church:

photo (106)

Full Day Schedule: ( Note, this could be broken up in separate pieces if this would be to overwhelming).

visual-schedule-for-a-day

Using visual schedules have been shown to be helpful for children and adults with special needs by giving them more control on what goes on in their daily lives.  It provides the road map to navigate for a smooth ride through their daily routines.  That’s what is in my noggin this week.

~Teresa 🙂

Follow Nick:

@Down Syndrome With A Slice Of Autism on Facebook and Pinterest

#nickdsautism on Instagram

@tjunnerstall on Twitter

 

 

 

Posted in Autism, Down syndrome, Feeding, Personal Hygiene, Toileting

Blog #104~ Parenting and Discipline

Posted on by tjunnerstall

Blog #104~ Parenting and Discipline

I recently was in a conversation with two young mothers of school age children. Both were talking about how much they did for their kids.  One mom commented that her daughter was old enough to make her own bed.  Yet she would do it herself because her daughter did it so sloppily.  The other one talked about scrambling to get the lunches made and double checking to see if all the homework was in their backpacks.  I scratched my head and wondered about this. Why weren’t they using these opportunities to help foster independence in their children?  I think as a mom, sometimes it’s just easier to do it yourself instead of constant reminders and nagging.  But in the long run, this does nothing to teach your child responsibility. Which brings me to my point this week; parenting is not only disciplining your child but also staying disciplined yourself.

When you are raising a child with special needs, it is even more difficult to teach independent living skills. Things take longer to learn with deficits in speech, gross motor and fine motor skills.  The process of putting on shoes and socks can be a ten minute ordeal.  With the bus coming at 7:25 a.m. the morning may not be ideal to use as a teaching moment. But you can carve out chunks of time to practice independent living skills during down times.

My son, Nick is now 20 years old. He has Down syndrome and autism.  Once at a high school conference, his teachers and therapists pointed out how good he was at self-care (in fact the strongest student in the class). I attribute this to three things:

1. Providing those teaching moments to practice skills

2. Using visuals so he can be prompted

3. Staying disciplined in the routine rather than just doing it myself

photo (105)

The most challenging thing I have ever done was getting my son with special needs toilet trained. It is also happens to be the greatest thing that I have accomplished in my life. It was certainly a marathon, not a sprint.  In fact it was the longest and hardest marathon imaginable.  And we stepped in a LOT of poop along the way.

poop icon

When I look back at that road, one thing stands out on how Nick finally got toilet trained. It was DISIPLINE! Yes, I worked with autism specialists, went to potty training workshops and used visuals.  But nothing worked until I disciplined myself to create a timed toileting schedule and stick with it.  This (combined with the fact that Nick finally was mature enough), led to the success of him getting out of Depends and into underwear.  And that was a glorious sight to see. 🙂

It was a long road but we made it to the other side, tada!

IMG04

The importance of staying disciplined as a parent will pay off in the long run. You can’t wipe your child’s bottom forever.  That’s what is in my noggin this week.

~Teresa

Posted in Autism, Down syndrome, Feeding, Personal Hygiene, Toileting, Uncategorized

Blog #92~One Yellow Hash Mark at a Time

Posted on by tjunnerstall

Blog #92~One Yellow Hash Mark at a Time

I just finished this book written by Chad Hymas:

chad

Chad had everything, a beautiful wife, two sons and a thriving business. One evening he made a rushed decision to ignore safety in favor of getting home quickly. Chad was anxious to see his baby boy take his first steps. On that day in 2001, at the age of 27, his life changed in forever when a 2,000-pound bale of hay shattered his neck leaving him a quadriplegic.

What follows is the story of how he fought back to gain his independence and ultimately setting a Guinness World Record by wheeling his chair from Salt Lake City to Vegas (513 miles) in 2003.

gwr

This was no easy task for Chad. There was some good news. His spinal cord wasn’t severed. He was able to regain important functions and have wrist movement as well as function in his biceps. In the book, he talks about starting out with his “personal Guinness records”.  They were the very basic things that most of us take for granted like putting his own shirt on, brushing his teeth, shaving, and even getting his drivers license. Chad overcame unsurmountable obstacles and continues to inspire others with his message on all 7 continents and 38 countries. He did it by letting go of his old ideas of who he thought he would be and reinvent himself.

The quest to set that Guinness World Record was daunting. The first few days went well. But the desert heat beat down on him, leaving his hands blistered and bloodied. He hits a wall, not able to fathom going another six days. His dad tells him to think of it as one day, not six days. He says “Just do one more day”. With his Father’s encouragement he broke down the goal into smaller increments. One day at a time became one mile at time. He was 90 miles away from his goal. But the mile markers seem too far apart. His Dad steps in, “Son, don’t give up. Break down the goal even more. Instead of mile markers, count the yellow stripes in the middle of the road. They come faster. See if that helps.” After eleven days Chad Hymas crossed that finish line setting a new Guinness World Record!

As I read his powerful message, I thought of all the “personal Guinness records” that my son Nick has mastered. Nick is 20 years old. He has Down syndrome and would later be diagnosed with autism. Low muscle tone is a trait of Down syndrome. It affects not only gross motor skills but also chewing and swallowing food.

A very low tone Nick flopping over on his brother, Hank……

scan0007

My son would not eat textured foods nor would he walk until he was nearly 4 years old. All the tasks to get him there were broken down, just as Chad Hymas did. It took Nick a long time to become independent with dressing, brushing his teeth and shaving. But he has hit all of those benchmark and then some.

I never imagined Nick would be able to do something like scuba diving…

Diveheart 2013 336 

Chad Hymas reminded me of something important. “Shift the focus on what I can do.”  His friend and mentor, Art Berg was right, “You and I can do anything anyone else can, if you’re willing to do it differently.” As I continue to help Nick become more independent, I am going to keep Chad in mind and tackle each task one yellow hash mark at a time. That’s what is in my noggin this week.

~Teresa

For more information about Chad Hymas: http://www.chadhymas.com

 

Posted in Autism, Down syndrome, Feeding, Personal Hygiene, Toileting

Blog #67~Dear Abby, Down syndrome and Autism Style

Posted on by tjunnerstall

Blog #67~ Dear Abby, Down syndrome and Autism Style…

Dear Abby

Advice Columnist, Dear Abby 🙂

It’s comforting to know that as a parent of a child who has Down syndrome and autism I can click the mouse and find support online. When Nick was born 19 years ago, a nurse handed me a couple of brochures on Down syndrome.  That was it!   This is the vision sustained me after hearing of Nick’s diagnosis of Down syndrome. Thank you, Chris Burke…..Actor, advocate, icon, my rock star!

Chris Burke

Ten years later we would meet Chris in person at the National Down Syndrome Congress convention.  (For more information: http:// www. ndsccenter.org)

My older son, Hank with Chris Burke at the NDSC  Convention……

Scan0004

There are several groups that I belong to on Facebook. (Just type in “Down syndrome and autism” in the search engine.) These parents are going through many adversities trying to get through the day and night with their kids.  Most are sleep deprived because their children are up all night turning on lights stimming, banging things against the wall, and opening and slamming doors.  I dedicate this week’s blog to these brave warriors who get up weary, reaching for the Visine and Advil to take on another day.

autism and sleep cartoon

Down syndrome and autism support groups are a safe haven to share war stories, tips, get advice, commiserate and laugh.  No one flinches when a parent writes about a walk on the local nature trail, and stopping to go back to their dawdling child.  The 11 year old stood there having just pooped in the middle of the path. What can I say but, it happens.   Topics last week were varied.  One mom needed help on how to explain and guide her daughter about getting her period.  I added a comment about a great book that tackles puberty and body privacy issues called:  “Taking Care of Myself,” by Mary Wrobel.  There were dozens of helpful tips from other parents who had daughters that had dealt with this issue.  Another parent had just given birth to a baby who has Down syndrome.  I was moved by all the support given to this new mom. Here are just a few of the many offered to her:

  • “Go home and bond and love your baby”
  • “Congratulations you have been blessed.”
  • “Get regular checkups and a heart echogram to rule out heart defects.”
  • “Low muscle tone may make it difficult to nurse your child but don’t give up.”
  • “Focus on the baby, not the Down syndrome.”
  • “Go to www.noahsdad.com it has great information presented positively.”
  • “Check out www.futureofdowns.com it has a lot of good information.”

It’s good to know that the struggles of feeding, toileting, hygiene, sleeping, sensory, gross and fine motor issues are felt by so many parents.   For a long time I was alone.  I pulled away from the Down syndrome support groups because I didn’t fit in.  Nick didn’t progress like the kids who just had Down syndrome.  After Nick’s diagnosis of autism I reached out to the Chicago based group, National Down Syndrome Association: http://www.nads.org.  Within NADS, there is a group is called “More than just Down syndrome.”  I found a new home here.  We have a unique bond because these parents get it!

We’ve have been through it all with Nick.  Our days are far from perfect. He still wakes up some nights but at least he isn’t banging the walls or turning on all the lights.  But some things have become easier as he has matured into an adult.  Just yesterday we gave him the best, most cooperative haircut ever!  Miracles do happen. 🙂

photo (5)

As I wrote about in Blog #66, reaching out to a support group has helped me realize that I am not alone on this path. I’m not the only one who has bent down and had to clean up my child’s poop.  Bless these warrior parents for getting up and fighting the good fight!  That’s what is in my noggin this week!

~Teresa

Posted in Autism, Behavior/ ABA, Education and Special Needs, Feeding, Personal Hygiene, Toileting, Tech Stuff/Apps and Video Based Instruction

Blog #52~ Tech Time

Posted on by tjunnerstall

geek pic

Blog #52~Tech Time

A few weeks ago at the National Association for Down Syndrome (NADS) Retreat the guest speaker did a presentation on using video based instruction and mobile technologies to support learners with Down syndrome and other developmental disabilities.  Toni Van Laarhoven, an associate professor in the Department of Special and Early Education at Northern Illinois University (NIU) gave us some great information on how to implement it.

Video modeling for can be used for teaching a variety of social, academic, and functional skills.  In the April 2012 archives, Blog #5~Ready, Set, Action, I wrote about how effective these have been in teaching Nick a variety of job skills.  He learned how to unload the dishwasher, load the washing machine and how to use the vacuum cleaner.

Nick vacumming_Tabor Hills (5)

Before video modeling we used social stories.  Basically this is like a script that you want the child to follow.  With Nick also having autism, it helps him to see it in picture form so he can better understand.  Nick has a thing for sneezing right in your face on purpose.  His teacher made this social story, here is part of it…….. aaaaachoooooo 🙂

photo (115)

These visual supports were effective, but his interest level when reading social stories was nothing compared to when he started watching the video models.

Here are a few ideas  I came up with for video modeling:

Teach a job skill

Teach a fine motor skill (cutting food, buttoning a shirt, pour milk, handwriting)

Teach a gross motor skill (swimming strokes, riding a bike, yoga positions.)

Grooming routines (brushing teeth, washing face, dressing.)

Bedtime routine

Change in routine (picture day at school, new curriculum unit in P.E., new school)

Visit to doctor, dentist, blood draws, and haircuts

Trip to the zoo, baseball game, mall, movie theater

Appropriate leisure activities to do at home (watch a movie, computer/X-Box)

Teach social skills (playing games with peers, turn taking)

It’s best to choose one behavior or skill to work on at a time.  Have the child watch the movie before engaging in the activity on a consistent basis.  For a job skill, many students have a video on their hand held device (iPod) and can follow the prompts as they work.  Ultimately, using video models can foster greater independence.

Shooting the videos can be done using an adult or peer model going through the sequence.  Simple verbal prompts should be provided.  For example, for pouring milk you can script it like this.

  1. Go to cabinet and get a cup.
  2. Go to the refrigerator and get milk.
  3. Open cap and pour milk in cup.
  4. Put cap on milk.
  5. Put milk container back in the refrigerator.

Another way to use video modeling is to make a video resume.  Toni made one of her sister who has significant disabilities.  This video showed in detail her routine.  The narrator pointed out specific details, likes, dislikes that added clarity to how she navigates her day.  This would be extremely helpful for a new staff, teacher, and direct care provider.  A few years ago, Toni’s NIU students put together a video resume of Nick called Project MY VOICE.  Like Toni’s sister, his showed what he did at school, his likes (music, community outings, etc..) and pointed out things that might upset him (saying “no” to him, changes in schedule, etc…)  Nick was very proud to show the video at his IEP meeting that year. 🙂

There tons of programs and apps that are available for assisting persons with special needs.  Here are just a few that have been recommended to me:

*Follow a schedule with Picture Scheduler:

picture schedule app

*iPrompts- Visual support, schedules, picture prompting for autism and special education.

*Artiks Pics-Vocabulary flashcards, memory games

*www.autismspeaks.org/autism-apps

*First Then Visual Schedule:

first then app

*ABA (Applied Behavior Analysis) and educational apps:

fruit app

happy sad app pic

Alphabet Tracing:

alphabet tracing

Sensory Fun, Light Box App:

light box app

Silly Fun, Talking Tom 2 (Nick’s going to love this one. Tom just cut one here, stinky) 🙂

talking tom

The list goes on and on, you get the idea.  There’s an app for just about everything.

Video based instruction, using mobile devices and prompting systems are effective tools in helping our kids navigate their world to become more independent. Put the power in their hands! That’s what is in my noggin this week.

~Teresa 🙂

Posted in Autism, Behavior/ ABA, Feeding, Personal Hygiene, Toileting

Blog #51~Pushing My Buttons

Posted on by tjunnerstall

Blog #51~Pushing My Buttons

Pushing the microwave and phone intercom buttons, running water faucets full blast, dumping out coffee mugs…. You name it Nick does it. I try to ignore the behavior and not give him any attention which is what he desires.  This tactic isn’t really working.  Now what?  Enter Toni Van Laarhoven, Associate Professor at Northern Illinois University.  She spoke at the NADS Behavior Retreat a few weekends ago.  Before she did her presentation on using video modeling to teach behaviors she spent some time talking about the struggles that we as parents were going through. The NADS (National Down Syndrome Association) retreat families all have children with Down syndrome and autism.  I sat up in my chair, she had my full attention. I began jotting notes in my journal frantically as she spoke.  I am always looking for solutions, she had me at DRO.  

It’s been a long time since my days of taking psychology classes at The University of Texas.

Longhorn logo

I remember the basics but this technique I have never tried with Nick.  What is DRO?  It stands for Differential Reinforcement of Other Behavior, and it is the delivery of reinforcement. This reinforcement procedure is designed to reduce a given behavior by increasing alternative behavior while withholding reinforcement for the unwanted response.

 I did a little research and have to give credit to Toni Van Laarhoven and these two resources: 

Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied Behavior Analysis (Second Edition). Upper Saddle River, NJ: Pearson Education, Inc.

Sulzer-Azaroff, B. & Mayer G.R. (1991). Behavior Analysis for Lasting Change. Belmont, CA: Wadsworth/Thomson

Here is my take on this technique and how I might apply it to help with some of Nick’s behaviors.  DRO is a specific schedule of reinforcement that is used to decrease the rate of behaviors that are inappropriate.  It is time-dependent, so rather than responding to a behavior after the fact you reinforce the time that the child is NOT engaging in the inappropriate behavior. In essence, you catch them being good. 🙂

angel pic

Advantages of using DRO: 

* Decreases inappropriate behaviors rapidly

* Positive approach to change inappropriate behaviors

* Used to reduce a wide variety of behaviors

* Easy to implement

Guidelines for implementing a DRO Program: 

* Define the target behavior.

* Determine highly preferred items or activities to be used as reinforcement.

* Collect baseline data of current behavior, how often does this occur?

* Set initial DRO intervals just below the average period of time that the child  emits the inappropriate behavior. (5, 10, 15 minutes?)

* Explain rules to earn reinforcement.  Child will earn reinforcement if they do not engage in the target behavior during each interval.

*DRO may be more effective when combined reinforcing replacement behaviors.

*Use visual supports (tokens, picture of reward)

*At the end of the time period, provide the child with the reward if the target  behavior was not emitted.

* If the child engages in the target behavior, inform them that there will be no reward at that time.

* Start time period and continue sequence above.

*Implement daily and consistently.

* As the student makes progress, increase the time period.

Here is what I picture with Nick.  The target behavior will be pushing the phone intercom button.  I will do some data keeping on how often he does this.  In addition, I will see what is occurring in the environment that might trigger him doing this and make a note in the behavior journal.  Once a pattern is established I will set the interval schedule.  Next will be determining what motivates Nick.  Normally he is rewarded with a Sprite when he does his work bins well.  However I am going to use a different reward specific to this DRO project.  Nick enjoys watching Funny Cats on You Tube and the laptop is right by the phone.  Right now I am thinking this might work.  I like the idea of doing a visual token system for Nick.  Toni mentioned making a puzzle of the highly preferred item.  For each successful interval you put a piece in the puzzle.  Once the puzzle is filled in then Nick would get his reward  🙂

you tube cat pic

The DRO technique could be used in home and in the classroom as well.  One instance might be a child who interrupts the teacher during classroom instruction. The end result is to have the child learn to exercise more self control.  This may sound like a lot of work.  The data keeping and setting of the interval schedule can be tedious.  Flashback to the toilet training days….. this is when I use to put Nick on the throne every 30 minutes and do a dry pants check.  I also kept data on how often he took in food and drinks. Over time I saw a pattern of two things.  First,  was how long he could stay dry and clean.  Secondly I figured out what amount of time it took him to digest what he ate and drank thus needing to use the bathroom. This is how I habit trained him.  As he matured he was able to self-monitor toileting on his own. Put the time and effort on the front end (so to speak 😉 ) and there will be a payoff.  That’s what is in my noggin this week….. Stay tuned…..

~Teresa 🙂

Posted in Behavior/ ABA, Feeding, Personal Hygiene, Toileting, Recreation/Leisure and Special Needs

Blog #22~ Grooming 101

Posted on by tjunnerstall

Blog #22~ Grooming 101

A few weeks ago in Blog #18~A Cut Above, I wrote about the joys ha ha… of giving Nick haircuts along with a few other grooming issues.  I thought this week I would expand with some information on overall grooming and fostering independence in hygiene and dressing routines. While it seems like something we all just do without thinking, it’s not as simple as that.

Well, maybe it is for a cat. Miss Mellie makes it look so easy and peaceful……

So where to start, tooth brushing, bathing, washing face and hands, dressing?  Several years ago, a wise autism specialist once offered this piece of advice.  “Pick one thing on the day you pay your bills each month and that is what you will work on with your child until the next monthly bill cycle.”  This helps you as a parent to focus on one goal without being overwhelmed.  The second *pearl of wisdom I have learned is to make sure you have a block of time where things are relaxed to teach these skills. Mornings are out for us since the bus gets here at 6:30 a.m.  Uh, no are you kidding me, 6:00 a.m. is not going to be a teaching moment.

Let’s start with brushing teeth.  I like use flip up caps on toothpaste as it is easier for Nick to open up on his own.   By the way, why does the toothpaste fall off a toothbrush so easily but it sticks to the sink like glue?  We use a lot of visuals to help Nick navigate his world.  Autism 101, if he can see it, he will understand it.  Here is the step by step sequence we use for brushing teeth.

I found these sequence boards in a software program called   “Functional Living Skills and Behavioral Rules.”  There are tons of visual prompts in this program!

This software program has step sheets for everything from showering to feminine hygiene steps.  In addition, it offers daily living schedules, community skills, and behavioral rules.  Another great resource is a book by Mary Wrobel called “Taking Care of Myself.”  This is a must-have for a parent with a special needs child. For showering the steps are posted on the outside of the shower door facing in for Nick….

I wrote the steps on the back. To prompt I slide my fingers to each the picture while Nick is showering….

Here are a few other visual ideas for shower and shaving …..

Over the years I have also used a lot of modeling of these tasks along with the visuals.  During Nick’s shower, I often pretend like I am washing too. Why, because Nick can get lost in “receptive words”.   Too much verbal cues get him caught up in the shuffle.  Wiki.answers.com explains it as this: “Receptive language”  is the comprehension of language – listening and understanding what is communicated. Another way to view it is as the receiving aspect of language. (Sometimes, reading is included when referring to receptive language, but some people use the term for spoken communication only.) It involves being attentive to what is said, the ability to comprehend the message, the speed of processing the message and concentrating on the message. Receptive language includes understanding figurative language, as well as literal language. Receptive language includes being able to follow a series of commands.”  So for Nick, it helps to use fewer words and focus on the visuals and modeling the desired behavior. For example rather than say, “Nick you need to get the shampoo and wash your hair.” I would either point to the shampoo bottle and mimic the action or simply say “Nick, wash hair.”  It is succinct and he gets it.

Time for me to get clean and slicked up!

The goal is to work to diminish the cues whether they are verbal, modeling or visuals. This idea is known as “Least Restrictive Prompting.”  Teaching a behavior starts with putting your hand over the child’s hand to show them how to do it.  Then literally you begin to fade back.  From there your hand is over the child’s wrist, then elbow, upper mid-arm, shoulder and finally letting go and being within close proximity.  The end result is to help him foster independence in all of these tasks.  To date, Nick is able to get his grooming bin out of the closet and follow a routine with success.  He also has hygiene built into his curriculum at school.

Here is Nick’s grooming bin. He also uses body spray but that is kept under the sink that has a childproof lock since he likes to take it and spray all over the place including right into your eyeballs (see more of these shenanigans in blog #10~ Nano Second.)

Last week in Blog #21, I mentioned the word “buck naked.” Nick has absolutely no problem undressing.  However getting dressed can be tricky.  He often puts his pants and shirts on backward still to this day.  By laying the clothes out a certain way, Nick is more easily able to get this done correctly. Note the shirt is laid out backwards so he can grab it from behind and pull it over his head.  The pants are laid out over his feet straight up so he can put one leg in at a time….

 Voila, it works! 🙂

Here is another idea.  Put a smiley face on with painters tape on the tag area and cue this to be in the back.

Bottom line is this…. As Nick’s mom, the biggest gift I can give my son besides love is to teach him to become independent in all of these tasks.  He will gain confidence, pride and hopefully a spot in a group home someday.  Not every day goes smoothly.   Sometimes we just have to get out the door, and if Nick is moving slowly I don’t force him to do it on his own. Pushing Nick too hard can lead to frustration on both our parts so I pick my battles.  Easy as a cat taking a bath, no but it can be done.  That’s what is in my noggin this week.  I hope the Grooming 101 tutorial was helpful and maybe enlightening.  Make it a good one and until next Monday and here’s to looking slick and sharp.  After all, as the ZZ Top says….”Every girl’s crazy about a sharp dressed man….”

~Teresa

*Pearl of wisdom according to wiki.answers.com says that “The biggest connection I can see between a pearl and wisdom is they both take a long time to develop. Also, both a pearl and wisdom seem like small objects but are both very valuable, and they develop from grit